What is the role of long-term immunosuppression therapy in the treatment of myasthenia gravis (MG)?

Updated: Aug 27, 2018
  • Author: Abbas Jowkar, MD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE  more...
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Answer

Long-term immunosuppression

  • Prednisone is the most important immunosuppressant and provides short- and long-term benefit.
  • Azathioprine (AZA) is a first-line steroid-sparing agent
  • Mycophenolate mofetil (MMF) is also a first-line steroid-sparing agent. It is widely used and less toxic than azathioprine.
  • Cyclosporine (CyA) is used as a steroid-sparing agent in patients who are intolerant to azathioprine and mycophenolate mofetil.
  • Tacrolimus is used as a steroid-sparing agent in patients intolerant or unresponsive to AZA, MMF, or CyA.
  • Methotrexate is used as a steroid-sparing agent and has similar efficacy and tolerability to AZA.
  • Rituximab may be an effective intervention in refractory MG, both for anti-AChR and anti-MuSK-positive disease. [5, 6, 7, 8]
  • Cyclophosphamide is used in refractory/severe MG.

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